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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
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Summary

Chemotherapy drugs are generally expensive. The cost of chemotherapy depends on factors such as: 

  • The kind of drugs used
  • The cost of the drug
  • How often you take the drugs
  • How long you take treatment
  • Where you take it
  • Side effects and the cost of treating them.

Your doctor can give you an idea of the cost of a recommended chemo treatment.   If paying for the cost is a problem, your doctor may also have ideas about financial assistance (such as from the pharmaceutical company). 

  • Chemotherapy drugs prescribed and given by oncologists are generally covered by health insurance.
  • For insurance purposes, chemotherapy given orally is generally considered to be a medication instead of a treatment. 
  • If you have health insurance, find out if your insurer will pay before starting treatment. If the company will not pay, appeal - and keep appealing. Persistence pays off. (For information about how to appeal, and strategies to use depending on why the company denies coverage, click here. If you are appealing a Medicare decision, click here. If you are appealing a Medicaid (Medi-cal in California) decision click here. )
  • If you do not have health insurance or are underinsured, many pharmaceutical companies offer medication assistance programs.  Check with your doctor to determine if you might be eligibile.
  • If you have health insurance and pay for a co-pay or for co-insurance or if you do not have health insurance and have to pay for chemotherapy totally by yourself, see our documents:  How To Deal With A Financial Crunch or Crisis and Uninsured for advice about how to maximize your resources to make the necessary payments, and how to find financial assistance if needed .

For additional information, see:

NOTE: We have information to help maintain control of your finances to retain as much of your lifestyle as possible while paying for chemotherapy. See Finances 

If You Have Health Insurance

  • Before you begin treatment, find out whether your insurance company or Medicare will pay for your care.
  • Most health insurance policies, including Medicare Part B, cover at least part of the cost of most kinds of chemotherapy.
  • Payment may depend on where the chemotherapy is given. For instance, some health insurance (such as Medicare) pays for chemo given in a doctor's office as part of the services the doctor provides. On the other hand, chemothearpy at home is considered to be a drug and requires you to pay more.
  • Payment may depend on the treatment chosen. If your insurer denies payment for your treatment, see: Chemo: If Your Insurer Refuses To Pay For.
  • It is advisable to do everything you can to keep your health insurance, even if you must be out of work for treatment.
  • If your insurance is through your job:
    • Learn about options that can help you keep your insurance, even if you quit your job.
    • You may be able to take time off and keep your health insurance either because of an employer plan or because you are entitled to under either Family Medical Leave or under the Americans With Disabilities Act.

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Health Insurance 101

If Your Insurer Refuses To Pay For Chemotherapy

According to the American Cancer Society, offsite link Insurance companies may deny payment for chemo for any of the following reasons. The company:

  • May not be aware of new treatments.
  • May limit the selection of drugs that doctors can use for chemo.
  • May restrict payment to the uses first approved by the Food and Drug Administration (FDA).
  • May say the treatment is experimental - especially if it is given through a clinical trial.

If your insurer denies payment:

  • Appeal! And keep appealing until you get a "yes."
    • Check your policy to find out what you have to do to appeal and by when.
    • Deadlines are important. If you miss a deadline, you may lose the right to appeal.
    • Tell your health care team.
    • The health care team may have encountered a similar situation before and have all arguments ready to go to get the decision changed. Even if not, the office will be critical to the process.
    • The doctor's office will hopefully even do the work for you. If the doctor's office offers to take over the work, it's in your interest to be part of the process.
    • Even if the doctor's office doesn't do the appeal work for you, it is in the doctor's interest to help with the appeal. For instance, the doctor can help locate scientific studies which show that a particular drug is effective for your particular cancer and stage. He or she can also help provide information about what is being done in the cancer community.
    • Ask hospitals and cancer centers where the treatment will be provided to help prove why the treatment is effective for your situation.
    • Contact the pharmaceutical company which manufactures the chemotherapy drug. The company can provide information to counter the insurance company's argument. It may even have specialists who will deal directly with the insurer for you.
    • To learn more, see the Survivorship A to Z document: Health Insurance: Appeals

A last alternative may be to sue the insurance company to get it to pay for your cancer treatment. In many cases, courts have sided with patients and ordered insurance companies to pay for a patient's treatment. If this alternative is necessary, see: How To Choose A Lawyer

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Health Insurance: Claims: Appeals

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Uninsured

If You Do Not Have Health Insurance

You may want to ask a social worker at your local hospital to help you look into payment through government programs such as Medicare.

Medicaid makes health care services available for people with financial need. Medicaid may help pay for certain treatments. Contact the office that handles social services in your city or county to find out if you are eligible for Medicaid and whether your chemotherapy is a covered expense. Medicaid approval can take a long time, so it is advisable to begin the process as early as possible. (NOTE: If necessary, you can likely give assets away and qualify for Medicaid to pay for chemotherapy right away. To learn more, see: Qualifying For Medicaid).

You can also contact your hospital's social service office which may be able to direct you to other sources of help.

Also look at our information about accessing medical care when Uninsured.

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Uninsured